ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 J18.2

Billable / Specific CC

Hypostatic pneumonia, unspecified organism

J18
Block
2
Synonyms
800
LCDs
13
Payer Policies
0
Linked CPTs

About ICD-10-CM J18.2

ICD-10-CM code J18.2 represents Hypostatic pneumonia, unspecified organism. This is a billable/specific code in the Respiratory System chapter (block J18). The 2026 edition of ICD-10-CM J18.2 became effective on October 1, 2025.

Coding Tips for J18.2

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

Inpatient DRG impact: CC

J18.2 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under J18.2. Per CMS ICD-10-CM Tabular 2026.

  • Hypostatic bronchopneumonia
  • Passive pneumonia

Inpatient DRG Impact, CC

codes Hypostatic pneumonia, unspecified organism. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.

Medicare LCD Coverage for J18.2

Local Coverage Determinations (LCDs) from CMS MACs that list J18.2 as a covered diagnosis.

800 LCDs

Showing top 10 of 800 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29131 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29260 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29580 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 97036 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29445 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 97542 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 97110 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 97533 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29130 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29405 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing J18.2.

13 policies

5 Medicare

Billing and Coding: Home Health Physical Therapy
Policy ID: ART-53058
Billing and Coding: Outpatient Physical Therapy
Policy ID: ART-53065
Billing and Coding: Computerized Axial Tomography (CT), Thorax
Policy ID: ART-56580
Billing and Coding: Respiratory Therapy (Respiratory Care)
Policy ID: ART-56717
Billing and Coding: Oximetry Services
Policy ID: ART-57205

CPT Codes Commonly Billed with J18.2

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for J18.2

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert J18.2 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
J18.2 514 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

Codes Adjacent To J18.2

Other codes in section J09-J18 (Influenza and pneumonia).

J09 Influenza due to certain identified influenza viruses (non-billable) J09.X Influenza due to identified novel influenza A virus (non-billable) J09.X1 Influenza due to identified novel influenza A virus with pneumonia J09.X2 Influenza due to identified novel influenza A virus with other respiratory manifestations J09.X3 Influenza due to identified novel influenza A virus with gastrointestinal manifestations J09.X9 Influenza due to identified novel influenza A virus with other manifestations J10 Influenza due to other identified influenza virus (non-billable) J10.0 Influenza due to other identified influenza virus with pneumonia (non-billable) J10.00 Influenza due to other identified influenza virus with unspecified type of pneumonia J10.01 Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia J10.08 Influenza due to other identified influenza virus with other specified pneumonia J10.1 Influenza due to other identified influenza virus with other respiratory manifestations J10.2 Influenza due to other identified influenza virus with gastrointestinal manifestations J10.8 Influenza due to other identified influenza virus with other manifestations (non-billable) J10.81 Influenza due to other identified influenza virus with encephalopathy J10.82 Influenza due to other identified influenza virus with myocarditis J10.83 Influenza due to other identified influenza virus with otitis media J10.89 Influenza due to other identified influenza virus with other manifestations J11 Influenza due to unidentified influenza virus (non-billable) J11.0 Influenza due to unidentified influenza virus with pneumonia (non-billable)

ICD-10 J18.2, Billing FAQ

Is ICD-10 code J18.2 billable? +

Yes, J18.2 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to J18.2? +

ICD-10 J18.2 includes: Hypostatic bronchopneumonia; Passive pneumonia.

Is J18.2 a CC or MCC for inpatient DRG? +

Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.

What ICD-9 codes does J18.2 map to? +

Per CMS GEMs, J18.2 maps to ICD-9 codes: 514. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

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